HomeMy WebLinkAboutUtility Company Approvaly SEWER
METER Sz.
�EMM
S
RES
M/F
IRR
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SECURITY DEP
SERVICE FEE
SAME DAY FEE
OVERTIME FEE
METER INSTAL
CFC/WATER
FPUA CFC
CFC/SEWER
GUAR. REV.
LATERAL
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• hr.,
ST LUCIE COUNTY WATER & SEWER DISTRICT (SLCU)
NEW CUSTOMER APPLICATION
NAME
SERVICE
Fort Pierce, FL 34945
SUBDNISIOJ� LOT / C�Zc BLOCK
BILLING ADDRESS-- - D &Iil�-. UC A A�,9� AZ
EMAILADDRESS:. DMPARR1N00-QRH0RT0N.00M
PHONE c/u► � `��� ��
MOVE IN/CLOSING DATE
This application hereby requests and authorizes the Utility to render water and/or sewage disposal
services to the premises described. above in accordance with the Utilities present or future rates, rules and
regulations, which by reference are made a part of this contract. Applicant agrees to pay Utility promptly for
such services in accordance with the established rules and regulations.
CUSTOMERS DEPOSITS ARE NON NEGOTIABLE OR TRANSFERABLE.
aAPPLICANT AGREES THAT APPLICANT WILL BEGIN PAYING BASE FACILITY CHARGES FOR THE UTHffY SERVICE
ICE
FOR ON THE DAY THE WATER MLTER OR OTHER UTILYTY SERVICE CONNECTTON IS INSTALLED AT
APPLICANT'S PROPERTY, REGARDLESS OF WHEN APPLICANT STARTS U=JZ][NG THE METERANDIOR SERVICE.
J.
CUSTOMER SIGNATURE T�4it Cliti2Ltt;s SOCIALSEC/FED ID
NAME OF SPOUSE
SPOUSE SOCIAL -
OFFICE USE ONLY
DATE -RECEIVED CASH CHECK# RECEIVED BY